Joseph H. McGlone, Inc.
Insurance Analyst
Joseph H. McGlone respects your privacy and will not share any information with another party without your consent.
For your ONLINE HOME QUOTE in
NJ and PA
please fill out and submit the following form:
Please fill out this form as complete as possible. If you are not sure of a response, leave it blank and we will contact you and help you obtain the information necessary for your quote.
Customer Information
 
Please choose:
 
 
 
Last name:
 
 
First name:
 
 
 
Address:
City, State, Zip:
E-mail address:
 
 
 
Home phone:
 
 
Work phone:
 
 
 
Property Information
 
Address:
 
 
 
Property type:
 
 
 
 
 
Construction:
Type of:
 
 
year built
 
 
 
If heated by oil: Where is the tank located?
 
 
 
Total living area:
 
 
square feet (do not include basement or garage)
 
 
Total area of foundation:
 
 
square feet (not required but helpful if available)
 
 
Is there a basement?
Is there a crawl space?
 
 
if yes, is it finished?
Is house on a SLAB?
 
 
 
Last Updated:
 
roof
electric
 
 
plumbing
heating
 
 
 
Number of:
 
baths
stories
 
 
fireplaces
garages
 
 
 
Does it include:
 
central air
 
 
fire ext.
 
 
pool
 
 
deck
 
 
sq. ft.
 
 
 
 
enclosed porch
 
 
open porch
 
 
porch size (sq. ft.)
 
 
 
 
fire alarm - central station
 
 
or local
 
 
 
 
burglar alarm - central station
 
 
or local
 
 
 
If new purchase:
 
settlement date
 
 
purchase price
 
 
Current Insurance Information
 
Name of Company:
Expiration date:
Deductible:
Current amount of
Insurance on dwelling:
Prior losses last 3 years:
 
 
 
Do you have any dogs? If yes, what breed?
Do you have a pool? If yes, in ground or above ground ?
Do you have a pool? If yes, in diving board and/or slide?
Do you have a flatroof? if yes, what %?
Do you have a trampoline?